Chemotherapy for paranasal sinus carcinoma. A 10-year experience at Wayne state university

Abstract

The role of chemotherapy in the management of patients with cancer of the paranasal sinus has not been defined. An analysis of 24 evaluable patients treated with chemotherapy as part of their overall therapy was performed. There were 16 male patients and eight female patients. Sixteen patients were previously untreated and eight had recurrent disease after surgery and/or radiotherapy. Six of the previously untreated patients had metastatic disease on presentation (four central nervous system (CNS) and two lung), and four recurrent patients had CNS involvement. The majority of patients (78%) had squamous cell carcinoma. The chemotherapy regimens included cisplatin (CDDP), vincristine (VCR), and bleomycin (COB), 5-fluorouracil (5-FU) infusion and CDDP, or 5-FU/CDDP and methotrexate (MTX). All patients had computed tomography (CT) measurable disease. Previously untreated patients underwent surgery and/or radiotherapy postchemotherapy. The overall response rate to chemotherapy for previously untreated patients was 82% (complete response [CR] 44%, partial response [PR] 38%) and for recurrent patients 88% (CR 38%, PR 50%). Predominant toxicities were nausea, vomiting, myelosuppression, mucositis, and renal impairment. The median survival of the previously untreated patients, based on response to chemotherapy, was as follows: CR 21+ months (range, 10+ to 81 months), PR 13.5 months (range, 2 to 21 months), and no response (NR) 3 months (range, 1 to 7 months). The median survival of patients with recurrent disease was as follows: CR 16 months, PR 13.5 months, and NR 5 months. We conclude that patients with paranasal cancers are responsive to CDDP-containing combinations. The role of adjuvant chemotherapy in previously untreated, locally advanced patients needs to be demonstrated by future randomized trials.

Locally advanced epithelial sinonasal tumors: The impact of multimodal approach

“…In this regard, the incorporation of induction chemotherapy (IC) into the treatment strategy with the aim to reduce distant metastasis and possibly impact on locoregional control has shown promising results despite having been obtained from heterogeneous series and within small studies. Favorable response to IC proved to be a strong positive prognosticator …”

Primary carcinoma of the frontal sinus with extensive intracranial invasion: A case report and review of the literature

“…It is unclear whether the use of chemotherapy and radiotherapy could improve the prognosis of frontal SCC. The overall response to chemotherapy is ~82%, and regimens based on cisplatin appear to be reasonably effective, particularly in association with 5-fluorouracil and bleomycin (12). A previous study (13) revealed that radiotherapy alone proved ineffective in advanced paranasal sinus carcinomas.…”

The role of systemic therapy in the management of sinonasal cancer: A critical review

“…One of the earliest reported experiences of this approach was a small study by Lorusso et al in which 16 untreated patients with advanced SNC, mostly of the squamous cell type, were treated with platinum-based chemotherapy followed by surgery and/or radiotherapy [25]. An overall response rate of 82% (complete response, (CR) = 44% and partial response, (PR) = 38%) was observed following induction therapy.…”

“…The choice of the type of chemotherapy according to histologically defined tumor type has not been specifically addressed in the reported trials. However, most of the previously reported studies employed platinum-based chemotherapy in combination with either 5-fluorouracil, taxane, ifosfamide, or vincristine [25][26][27][28][29].…”

“…For SNC, a favorable response to induction chemotherapy is often associated with improved survival and a reasonable chance of organ preservation [25,28,29,38]. This raises several questions.…”